Robinson Shenandoah
Continuum (Minneap Minn). 2025 Jun 1;31(3):850-864. doi: 10.1212/cont.0000000000001578.
This article highlights important concepts of caring for patients with childhood-onset hydrocephalus across the lifespan, emphasizing recent advances and current areas of controversy.
There are numerous causes of symptomatic hydrocephalus in neonates, infants, and children, and each etiology predicts the typical clinical course across the lifespan. Because the major cellular components essential for CSF dynamics develop predominantly during the third trimester and first 6 months after term birth, directly overlapping with the onset of many types of fetal, neonatal, and infantile hydrocephalus, the timing of onset impacts lifelong management. The treatment of childhood-onset hydrocephalus varies dramatically worldwide due to the differing etiologies and access to neurosurgical interventions. The surgical options for CSF diversion have advanced over the past decade, with a better appreciation of which techniques are more successful for the various types of childhood-onset hydrocephalus. These advances include using temporary shunt devices to delay permanent CSF diversion and endoscopic third ventriculostomy, at times with choroid plexus cauterization.
Etiology and age of onset impact the lifelong management of individuals living with childhood-onset hydrocephalus, with a rapid pace of evidence-based changes in clinical practice.
本文重点介绍了在整个生命周期中照顾儿童期脑积水患者的重要概念，强调了近期的进展和当前存在争议的领域。
新生儿、婴儿和儿童出现症状性脑积水有多种原因，每种病因都预示着其在整个生命周期中的典型临床过程。由于脑脊液动力学所必需的主要细胞成分主要在孕晚期和足月出生后的前6个月发育，这与许多类型的胎儿、新生儿和婴儿脑积水的发病时间直接重叠，因此发病时间会影响终身管理。由于病因不同以及获得神经外科干预的机会不同，全球范围内儿童期脑积水的治疗差异很大。在过去十年中，脑脊液分流的手术选择有了进展，人们对哪些技术在各种类型的儿童期脑积水治疗中更成功有了更好的认识。这些进展包括使用临时分流装置来延迟永久性脑脊液分流以及内镜下第三脑室造瘘术，有时还会进行脉络丛烧灼术。
病因和发病年龄会影响儿童期脑积水患者的终身管理，临床实践中基于证据的变化速度很快。
